Category: Access to Care

Half of the Americans who remain uninsured several years into Obamacare are eligible for government assistance in buying coverage, a new survey shows.

In less than three weeks, the Obama administration will embark on the third enrollment period under the 2010 Affordable Care Act, where it faces the ongoing challenge of persuading those who have resisted obtaining health coverage to buy it. About 32 million people, or about 11 percent of the U.S. population, are still uninsured.

By liberal and media acclamation, ObamaCare is a glorious success, the political opposition is fading and the entitlement state has gained another permanent annex. The reality, for anyone who cares to look, is different and suggests that ObamaCare is far more vulnerable than this conventional wisdom.

Joshua Smith, a Rockland County insurance broker, was deluged with questions from clients after regulators said they were shutting down Health Republic Insurance of New York, which was known for having some of the lowest rates in the state.

“It’s been a week of craziness,” said Mr. Smith, who owns Vanguard Benefit Solutions LLC, which enrolled about 75 small businesses in Health Republic’s plans. “Lots of emails, lots of calls, and everybody is nervous about what is going to happen.”

In apparent recognition of the distinct unpopularity of the Affordable Care Act’s Cadillac tax—an excise tax on high-value, employer-provided health benefits—more than 100 economists have signed a letter defending it. As the Washington Post headline about the letter read: “101 Economists Just Signed a Love Letter to the Obamacare Provision Everyone Else Hates.”

One of the consumer complaints levied against Affordable Care Act (Obamacare) health plans is that their provider networks are often narrow,1 creating both a high ratio of patients to doctors2 and increasing the risk for out-of-network care.3 With respect to out-of-network care, when enrollees go out-of-network for healthcare, many Obamacare plans will not cover the costs except in the case of a medical emergency or if a prior authorization from the plan had been formally submitted and then approved by the health plan. Moreover, unlike in-network healthcare, out-of-network medical care does not have its annual costs capped by the Affordable Care Act to prevent catastrophic medical expenses.

Stephanie Douglas signed up for health insurance in January with the best intentions. She had suffered a stroke and needed help paying for her medicines and care. The plan she chose from the federal insurance exchange sounded affordable — $58.17 a month after the subsidy she received under the Affordable Care Act.

But Ms. Douglas, 50, who was working about 30 hours a week as a dollar store cashier and a services coordinator at an apartment complex for older adults, soon realized that her insurance did not fit in her tight monthly budget. She stopped paying her premiums in April and lost her coverage a few months later.

The two largest state health insurance co-operatives created as part of a grand ObamaCare experiment have announced they are closing at the end of this year, joining others that have failed and even more that are insolvent and likely to fail.

The Kentucky Health Cooperative announced on Friday it is going out of business and will not enroll new members next year, leaving 51,000 members to find other coverage. It had the second-largest co-op enrollment in the country, garnering 75% of people who enrolled in coverage through the state’s health exchange.

The largest private provider of health insurance policies on Kynect, Kentucky’s health insurance exchange, is going out of business.

The Louisville-based Kentucky Health Cooperative Inc. announced Friday that it will end current memberships on Dec. 31 and will not add new members because of financial problems. It will not offer health insurance plans on Kynect when open enrollment for 2016 coverage starts on Nov. 1.

Mercy will be the 58th rural hospital to close in the United States since 2010, according to one research program, and many more could soon join the list because of declining reimbursements, growing regulatory burdens and shrinking rural populations that result in an older, sicker pool of patients. The closings have accelerated over the last few years and have hit more midsize hospitals like Mercy, which was licensed for 75 beds, than smaller “critical access” hospitals, which are reimbursed at a higher rate by Medicare.

Consumers shopping on the government’s health insurance website should find it easier this year to get basic questions answered about their doctors, medications and costs, according to an internal government document.

A slide presentation dated Sept. 29 says HealthCare.gov’s window-shopping feature is getting a major upgrade. Window shopping is a popular part of the website that allows consumers to browse for taxpayer-subsidized health insurance plans. A copy of the document from the CMS was provided to the Associated Press.